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NPI Code Detail

MEDICARE: JESSICA R SMITH LMT

MEDICARE: JESSICA R SMITH LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist0019017575VA

General Provider Information

NPI Number : 1356206965
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA R SMITH LMT
Provider Business Mailing Address
First Line : 1253 NIMMO PKWY STE 110
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23456-7782
Country : US
Telephone Number : 757-918-7761
Fax Number : 757-689-3597
Provider Business Practice Location Address
First Line : 1253 NIMMO PKWY STE 110
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23456-7782
Country : US
Telephone Number : 757-918-7761
Fax Number : 757-689-3597
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2025
Last Update Date : 12/17/2025

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Directions to “ JESSICA R SMITH LMT” Practice Location

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